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Keywords:

  • mortality;
  • long term illness;
  • multi-level models;
  • small areas;
  • deprivation;
  • affluence

Abstract

This paper considers morbidity and mortality variations at the small-area level in England and Wales and their relation to socio-economic factors. Separate affluence and deprivation effects on illness and mortality are identified from a single-level analysis, both exceeding the influence of social class, urbanity or ethnicity. A multi-level perspective is then adopted to explore ecological associations operating both at micro-area and higher level spatial scales. Contextual effects (higher level variability in the impacts of ward level variables) are identified in the effects of small area deprivation on mortality and illness, as well as cross-level interactions; thus the impact of small area social structure on health is partly defined by the wider regional and district setting. © 1997 John Wiley & Sons, Ltd.